Taking health promotion on to the streets

In Brazil, until 1990, the authorities could legally arrest a child found alone in the streets, and put them in prison-like institutions. Their crime? To be poor, usually black and living on the streets. The Brazilian Center for the Defense of the Rights of Children and Adolescents (SOS Crianca) was set up a few years ago with the aim of changing this legislation. Together with other nongovernment organizations, SOS Crianca drew up new legislation, lobbied politicians and policymakers, and publicized the issue at a new Child and Adolescent Statute, based on the International Declaration of Children's Rights, was made law. Lawyers volunteered their services to SOS Crianca, making sure that young people had access to legal support, so that the new law could be put into practiced. AIDS has added to the difficulties of young people living on the streets. In 1988, using a strategy similar to the one above, SOS Crianca started to work with key organizations and the children themselves, to draw up an HIV prevention strategy for street children. As well as being threatened with violence and police arrest, these children lack a basic human right--access to health care. Public health services in Brazil do not reach the 40% of the population who live in absolute poverty, which includes young people on the streets. Preventing AIDS is seen by SOS Crianca to be just a part of promoting better health and providing overall healthcare. Educational activities will not work if children do not have access to treatment, or to basic needs like food and shelter. SOS Crianca does not employ doctors because it is not the role of nongovernment organizations to take over the state's responsibility to provide basic health care. But how can the public clinics, staffed with underpaid professionals and lacking basic equipment meet the needs of street children? Meetings were organized with different health professionals, involving those most sensitive to the problem in setting up a referral system. Little by little we made progress. One day a doctor would make the appointment timetable more flexible, and the next a nurse would come to help develop counselling sessions. This support has helped to change the attitude of other health professionals towards these young people. Now a child on the streets can be told: "Go to this hospital, and you will be well treated." Our street educators try to give the children themselves an awareness of their right to use public health care facilities. The educators work every night on the streets, giving advice and counselling and assessing the children's health problems. In the mornings and afternoons the educators go with them to the clinics or follow up with other types of referrals. SOS Crianca also has an ongoing prenatal care program for girls and an STD diagnosis, counselling and treatment program, which includes HIV/AIDS. How many young people does SOS Crianca reach? The answer is not only to do with the numbers seeking health care, but also how many clinic doors are open to them. More and more young people, not just those living on the streets where SOS Crianca works, but others in poor communities, are using the service. It is called "Health Maloca," because the children call their makeshift homes--shelters made of cardboard and newspaper--"malocas." The name also symbolizes that these young people need to find their own ways of taking more control over their bodies and lives.